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Agenda Overview of recovery Overview of peer support Matching services & peer support to stages of recovery Integrating peer support with traditional services Peer services in Hamilton County Statewide Activities of importance

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Overview of Recovery

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Recovery: What It Is “A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles …recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), In 1999, the Ohio Department of Mental Health defined recovery as…“the process of overcoming the negative impact of a psychiatric disability despite its continued presence.” In 2012, SAMHSA defines Recovery for both mental health and alcohol and substance abuse as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA (2012). Working Definition of Recovery.

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Recovery: The Process Four Major Dimensions that Support a Life in Recovery: Home : a stable and safe place to live; Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing. Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community: relationships and social networks that provide support, friendship, love, and hope. SAMHSA (2012). Working Definition of Recovery.

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Recovery: The Process Guiding Principles of Recovery: Recovery emerges from hope Recovery is person-driven Recovery occurs via many pathways Recovery is holistic Recovery is supported by peers and allies Recovery is supported through relationship and social networks Recovery is culturally-based and influenced Recovery is supported by addressing trauma Recovery involves individual, family, and community strengths and responsibility Recovery is based on respect SAMHSA (2012). Working Definition of Recovery.

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Recovery: The Result

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Overview of Peer Support

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What is Peer Support Grew out of early advocacy efforts (history) “Relationships built and nurtured through shared experiences. People who have liked experiences can better relate and can consequently offer more empathy and validation.” (Sherry Mead)

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Purpose of Peer Support Advocacy To utilize shared experiences as a means to connect with and foster the recovery of other individuals with a mental illness To engage consumers who otherwise may not be willing to receive services To provide a more relaxed relationship To compliment clinical services

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Evidence: Effectiveness of Support Peer support and peer provided services are considered “promising practices” Peers do as well as non-peers on most outcomes (no significant differences) ACT teams with peer specialists have experienced better outcomes Working as a consumer provider fosters empowerment, self-esteem, and a shift in meaning and purpose

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Matching Support to Stages of Recovery

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Stages of Recovery Dependent/Unaware (Hope) Consumer relies on others and is not aware of his/her own status or needs. Dependent/Aware (Empowerment) Consumer relies on others but is aware of his/her status and needs. Independent/Aware (Self-Responsibility) Consumer relies on self and is aware of his/her status and needs. Interdependent/Aware (Meaningful Role) Consumer relies on self and others in a mutual exchange of beneficial support, services and resources. ODMH (1999) Emerging Best Practices in Mental Health Recovery. Stages in parenthesis are from the Village Integrated Services, Inc.; Long Beach. CA

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Hope Peer Support: Peer support is informal Interactions typically occur in treatment settings The result of being at the same place at the same time) Focus is often on mental illness rather than recovery Clinical and family support is often as important as peer support at this stage

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Self Responsibility Provider Services: Reduced medical somatic Transition out of case management Therapy Vocational services Supported housing/education Transition out of day/psychosocial programs Focus on self-esteem and continued empowerment Peer Support: Peer Support takes on an equal, if not more important role as clinical support. Peer support is more likely to occur outside the formal treatment environment. Peer support occurring in the community and is based on shared interest rather than illness. People in recovery begin to “give back”….they become volunteer or paid staff.

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Meaningful Role Provider Services: – Medical somatic only services – Safety net for other services should the need surface Focus on utilization of natural supports and, for some, transition from mental health services. Peer Support: Peer support occurs in the natural environment. At this point, some individuals “graduate” from the system and gain support though non-consumer relationships. If remaining a part of the consumer culture, individuals at this stage are the givers of support…they receive their support elsewhere. Providing support becomes a meaningful role!

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Support That Hinders Recovery Support that doesn’t match the needs and desires of the individual – e.g. providing peer-to-peer classes to a person who has acute clinical needs is far less effective than having a peer available for that individual to talk to. Support that doesn’t encourage and facilitate growth…that doesn’t help an individual establish and reach his/her goals – e.g. doing things for a person that they are capable of doing for themselves, or learning to do for themselves.

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Support That Hinders Recovery Support that doesn’t end – Avoid the Hotel California syndrome… when peer support is no longer necessary and/or beneficial, the person should be encouraged to transition to something else (i.e. natural supports in the community). Support that is controlling – If the relationship is hierarchical, there’s a problem Support that is stigmatizing – We can’t criticize mental health professionals and the community for stigmatizing those with a mental illness if we also do it!

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Integrating Peer Support “Recovery is the mending process that reweaves Human Beings back into the fabric of our society” And… Peer Support is a critical ingredient of recovery.

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Activities at State & National Level Ohio Empowerment Coalition COS Director’s Association (OCOSA) Medicaid billable peer services – Medicaid elevation – Currently 29 states have Medicaid billable peer services….Ohio is trying to become the 30 th – National Standards being developed – National Credentialing being considered